Home infusion therapy guidelines for drug deliveries reinforced

Home infusion therapy drugs delivered to a patient shouldn’t exceed a seven-day supply. The Blue Cross HIT Provider Manual states that, “No more than a seven-day supply of drugs may be delivered to the patient or a 10-day supply for a holiday weekend.”

We understand that there will be situations when a patient needs a drug delivery quantity of more than the allowed seven days. The following drug delivery exceptions are acceptable as long as the pharmacist receives a verbal order from the physician to send an additional quantity:

• When the pharmacist delivers a three-day drug supply, the next delivery quantity during the same infusion week shouldn’t be more than four-day supply. This delivery combination would meet the seven-day drug supply requirement.
• During the first week of drug therapy, additional drug quantities can be added to the delivery to accommodate the provider’s delivery schedule.
• Because of the possibility of a drug reaction, providers who want to closely monitor a patient’s first dose might not want to deliver the entire week’s drug supply. In this case, the remainder of the drug delivery can be delayed until the next delivery date.
• When the length of drug therapy lasts more than seven days but less than 14 days, the delivery of the entire drug therapy is acceptable

Blue Cross also won’t recover payments from HIT providers for drugs under following circumstances:

• Drugs that remain in the home when the therapy is prematurely discontinued
• The patient is unexpectedly hospitalized after a drug delivery
• The drug is changed midweek following a drug delivery

If you have any additional questions or concerns about these guidelines refer to the current Blue Cross HIT Provider Manual.